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General NPI Number Information
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NPI Number | 1942017959
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Entity Type | Individual
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Provider Name | MARENA DE JESUS APRN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 14101 PARKWAY COMMONS DR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-6012
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Country | US
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Telephone | 405-749-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 10304 EXTER AVE
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City | YUKON
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State | OK
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Zip | 73099-7564
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Country | US
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Telephone | 321-276-7430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 219385
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License Number State | OK
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